A Qualitative Study Exploring the Relationship of Curricular Models to the Development of Clinical Reasoning Skills Among Medical Students

Khin-Htun, S.^1* & Kushairi, A.²

¹Medical Education Fellow and Honorary Assistant Professor, University of Nottingham, United Kingdom
²Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom

Swe Khin-Htun, Medical Education Fellow and Honorary Assistant Professor, University of Nottingham, United Kingdom.

Keywords: Curriculum Model; Clinical Reasoning; Medical Education

Abstract

Current literature shows mixed evidence on the impact of curricular models on the development of Clinical Reasoning (CR) among medical students. The University of Nottingham (UoN) has two curricular groups: Graduate Entry Medical (GEM) students who have Problem based Learning (PBL) curriculum and Undergraduate entry medical students who have integrated curriculum for the first few years and they all join together later for clinical years from Clinical Phase (CP) 1 to final year CP3. The present research project aims to add to the body of knowledge within this field of research by exploring the effect of the different curricula used at UoN on the development of awareness of CR. The qualitative study was conducted to get a deep understanding of the students’ point of view.

The students were interviewed at the start of their CP1 and CP3 after gaining consent. Total numbers of participants after meeting the point of data saturation were 28 students. Inductive data analysis was conducted to the manifest, semantic or explicit level.

Results of the analysis revealed that all integrated CP3 students recalled PBL students had better CR skills at the start of their first clinical year. This view was also echoed by almost all PBL CP3 students agreeing that their CR was better. Among the integrated CP1 students, 50% said that PBL students had better CR. However, all CP3 students uniformly accepted that there was no discrepancy in CR between the two groups later such as at the end of CP1 or the entry of CP3 or during CP3.

Some students think that the difference in curricular model translates into difference in CR. Besides the curricular models, other factors that affect CR also emerged, such as the difference between undergraduate and graduate students’ confidence, motivation, background, life experience, timing of the clinical phase and exposure to clinical practice.

In conclusion, there is a discrepancy between CR skills between undergraduate integrated students and graduate PBL students at the beginning of CP1 which gradually decreases as the course progresses. The discrepancy in CR can be explained by differences in the curriculum model as well as other factors.

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